Prostate Cancer Spreads as Surgery is Delayed for Alternative Radiation Therapy


This case involves a forty-two-year-old male patient who was diagnosed with Stage III prostate cancer. The pathologist revealed on the initial pathology report a carcinoma of the prostate, with Gleason scores of 10 in several regions.  A bone scan at the time revealed no evidence of metastatic disease and surgery was not recommended by his physician, but rather intraoperative, focused radiation and hormone deprivation therapy was initiated. The patient tolerated the treatment well with the exception of new onset urinary frequency and a constant feeling of incomplete emptying. At this time, the radiation oncologist ordered a full workup, including a bone scan and a CT of the abdomen and pelvis.  The bone scan showed widespread metastatic disease to the spine, ribs, shoulders and pelvis.

Question(s) For Expert Witness

  • What are the current accepted guidelines on approaching newly diagnosed prostate cancer?

Expert Witness Response

According to American Cancer Society, the lifetime risk of developing prostate cancer 16%, and about 2.9% die from prostate cancer. Most die of other causes unrelated to the prostate cancer. The American Urological Association guidelines recommend that decisions regarding treatment depend on the patient for the various treatment options, with consideration of complications, adverse effects, relative efficacy, and quality-of-life issues. The first screening measure is obtaining the PSA level. If elevated, then further workup is needed as with this patient. There are many ways to treat prostate cancer. For advanced prostate cancer, radiation therapy along with androgen ablation can be performed whereas radical prostatectomy may be an appropriate alternative to radiation therapy in some cases. Ultimately, the urologist, oncologist and the patient must determine the best strategy for treatment who have metastasized lesions.

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